Overview of Neonatal Simulation & The Drivers for Development Joe Fawke, Jonathan Cusack & Christina Halahakoon
Food for thought When a person steps on a plane, their risk of dying in an air crash is one in 10 million. When a person is admitted to hospital, their risk of dying or being seriously harmed by medical error is one in 300.
CMO s 2008 Annual Report Evidence shows that simulation can: Be used to rehearse emergency situations e.g. airline industry, military, NASA Be used to train and assess teams to improve safety Provide training for surgical skills and surgeons trained in this way make fewer errors Offer an important route to safer care for patients Simulation training in all its forms will be a vital part in building a safer healthcare system SAFER MEDICAL PRACTICE: MACHINES, MANIKINS AND POLO MINTS. CMO Report 2008
CMO s Report Key Recommendations Simulation based training should: be fully integrated within clinical training be valued and adequately resourced by the NHS have expert clinical facilitators to deliver high quality training And: A national centre for simulation techniques should be established
Evolving national strategy for simulation training DH initial aims were to: Review simulation practice & of the availability / use of simulation facilities for NHS staff Identify & build on existing best practice Increase multidisciplinary simulation training Recognise the CMO s recommendations Seek input from stakeholders (Deaneries, Commissioners, PCTs)
RCPCH Drivers be patient centered and service driven be educationally coherent be innovative and evidence based deliver high quality educational outcomes deliver value for money ensure equity of access and quality of provision
Time for Training A Review of the impact of the European Working Time Directive on the quality of training Professor Sir John Temple 9 th June 2010 The Secretary of State requested that Medical Education England (MEE) commission an independent Review of the impact of the EWTD on training in relation to Dentists, Doctors, Healthcare Scientists and Pharmacists.
Time for Training Simulation is a developing science, with the ability to teach and objectively assess skills required to become a proficient practitioner. Technologies such as simulation can propel the trainee along the learning curve and reduce errors. One of the major benefits of training using simulation is that it enables a review of performance and the ability to make errors without clinical consequences.
Improving Neonatal Outcomes Factors identified: Institution level incentives to training & safety culture Relevant in-house training Non-threatening training for entire workforce Multi-professional teams: clinical & teamwork training Realistic training tools high fidelity rather than high tech Self directed infrastructural changes local solutions to national problems Siassakos et al. The active components of effective training in obstetric emergencies. BJOG 2009;116(8):1028-32 Draycott et al. Does training in Obstetric emergencies improve neonatal outcome? BJOG 2006;113:177-82
Feedback & simulation Evidence to show that a high fidelity simulator used in conjunction with appropriate feedback can improve performance in simulated assessments. Improving cardiopulmonary resuscitation quality and resuscitation training by combining audiovisual feedback and debriefing. Dine et al. Critical Care medicine 2008 vol 36 no. 10 The impact of constructive feedback on training in gastrointestinal endoscopy using high fidelity, virtual reality simulation: a randomised control trial. Kruglikova et al. Gut 2010;59:181-85
National groups BAPM simulation framework ASPiH RCPCH TEL NeoSim national conferences / ARNI course / website
Point of Care Simulation Advantages: Train in own clinical environment Teams that work together train together More accessible Less detrimental to service commitments More frequent
Training or Assessment? Issues around assessment using simulators: Level of reality Reproducibility Standardisation of scoring systems Defining standards Evidence base for effect on outcomes
Training or Assessment? NLS airway test Other Resuscitation Council (UK) courses START assessment Are you assessing an individual or team performance?
Regional Simulation Drivers Health Education England / LETB Commissioners Equity of access Medical / Nursing Schools Trainees Existing neonatal networks
Successful Regional Programme Consistent standardised training Strong project management Implementation strategy Local enthusiasm Regional funding Targets Local in-situ delivery Centralised Instructor Training Local in-situ delivery Local in-situ delivery
Successful national programme consistent, standardised training coordinated equipment range of units included local enthusiasm nominated lead Local in-situ delivery Local in-situ delivery Outreach Instructor Training Centralised Instructor Training Local in-situ delivery Local in-situ delivery Local in-situ delivery
25 courses Average of 10 / course Commissioned by: East Midlands East of England West Midlands Yorkshire North East Scotland Expressions of Interest from Northern Ireland Southwest Hong Kong! Current waiting list 55 people
Whose going to run your simulation programme?
Advanced Resuscitation of the Newborn Infant